C. J. Lockwood, E. Kuczynski
Markers of risk for preterm delivery
Clinical and experimental evidence indicate that PTD
results from four primary pathogenic mechanisms: activation
of the maternal or fetal HPA axis; amniochorionic-decidual or systemic inflammation; decidual hemorrhage;
and, pathologic distention of the myometrium.
Each of these four pathways has a distinct epidemiological
and clinical profile, and unique biochemical and
biophysical pathways initiating parturition, but shares a
common final biochemical pathway involving myometrial
activation and stimulation, and enhanced genital
tract protease activity promoting PPROM and cervical
change. Traditional methods of predicting women at
risk relying on obstetrical history or symptoms and epidemiological
risk factors are neither sensitive nor specific.
Recent approaches to predicting PTD, including
sonographic measurement of cervical length and biochemical
assays for hCG, cytokines, fFN, MMPs, estrogens,
and CRH, are more sensitive than traditional
methods. Moreover, given the heterogeneous, interactive
etiopathogeneses of PTD, multiple biochemical
markers should not only increase sensitivity and specificity,
but also permit the detection of the relative contribution of each pathogenesis to the overall risk of
PTD.
Journal of Perinatal Medicine, Walter de Gruyter
Print ISSN: 1619-3997
Volume: 27, 03/1999
Pages: 5 - 20
Show full article (external site)
Show all available items of this journal
Search
